Drug classes geriatrics

Common drug classes in the geriatric population

psychotropic

neurologic agents

pain and inflammation

cardiovascular

pulmonary

GI

hormonal

infections

cancer

Psychotropic medications- Affect

mood, behavior, other aspects of mental function

Psychotropic medications- purpose

treat anxiety, psychiatric disorders, insomnia, depression

Psychotropic medications- types

benzodiazepines

non-benzodiazepines

anti-psychotics

antidepressants

Benzodiazepines end in

-pam or -lam

Benzodiazepine cons

may predispose to alzheimer's and dementia

stays in system for geris 4x longer

geris are more sensitive to ADRs

Benzodiazepine tolerance

higher tolerance after 4 weeks--> higher dependence

Common Benzodiazepine ADRs

hangover- increased sleepiness

anterograde amnesia (decreased short term memory)

rebound insomnia (cant fall asleep)

dizziness

confusion

delirium

falls

Common benzo sedatives

Estazolam (ProSom)

Flurazepam (Dalmane)

Temazepam (Restoril)

Triazolam (Halcion)

Common benzodiazepine anti anxieties

Chloriazepoxide (Librium)

Alprazolam (Xanax)

Diazepam (Valium)

Lorazepam (ativan)

Clonazepam (Klonopin)

Non-benzodiazepines effects vs benzodiazepines

Safer and more tolerated

Less ADRs

Common Non-benzodiazepine sedatives

Eszopiclone (Lunesta)

Ramelteon (Rozerem)

Suvorexant (Belsomra)

Zaleplon (Sonata)

Zolpidem (Ambien)

Common Non-benzodiazepine anxiety

Buspirone (BuSpar, Vanspar)

Quetiapine (Seroquel)

Pregabalin (lyrica)

Antidepressants

common in older adults due to various social and health issues

Types of antidepressants

Tricyclic antidepressants (TCA)

Monoamine oxidase inhibitors (MAOI)

Newer second generation drugs like SSRIs or SNRIs

TCAs side effects

anticholingeric (dizziness, confusion, dry mouth, urinary retention)

serious cardiotoxic effects after OD

TCAs other uses

treat GI spasms and can help in individuals with IBS

MAOIs side effects

OH

Insomnia

SSRIs/SNRIs side effects

Less tendency for OH, anticholinergic, and sedation effects

GI irritation, upper GI bleeds

Serotonin syndrome

Serotonin syndrome!

Drug toxicity with high levels of serotonin

Confusion, hyper-excitability of muscles/nerves, heart rate, shivering/shaking

Common TCAs

amitriptyline (Elavil)

imipramine (tofranil)

nortriptyline (Aventyl, Pamelor)

trimipramine (surmontil)

Common MAOIs

Isocarboxazid (Marplan)

Phenelzine (Nardil)

Selegiline (Emsam)

Tranylcypromine (Parnate)

Commin SSRIs

Citalopram (Celexa)

Escitalopram (Lexapro)

Fluoxetine (Prozac)

Fluvoxamine (Luvox)

Paroxetine (Paxil)

Sertraline (Zoloft)

SNRIs

Desvenlafaxine (Khedezla, Pristiq)

Duloxetine (Cymbalta, Irenka)

Venlafaxine (Effexor)

Bipolar disorder (aka manic depression) treatment

Lithium

Lithium cannot

degrade into inactive form

Lithium has an increased risk for

toxicity

as soon as it enters their body it is active until excreted (older adults will have it in their body longer due to decreased excretion)

Symptoms of lithium toxicity

metallic taste in mouth

hand tremors

weakness

fatigue

incoordination

blurred vision

Lithium toxicity

cause irreversible cell damage, coma, death

Immediate medical attention!

Antipsychotic medication first-generation (conventional) side effects

sedation

anticholinergic

PH

extrapyramidal effects (dyskinesia)

Antipsychotic medication second-generation (atypical) side effects

cardiovascular toxicity

weight gain

metabolic disturbances that resemble DM

Antipsychotic medication first-generation common medications

chlorpromazine (ormazine, thorazine)

haloperidol (haldol)

loxapine (loxitane)

molindone (moban)

prochlorperazine (compazine)

thioridazine (mellaril)

Antipsychotic medication second-generation common medications

aripiprazole (abilify)

clozapine (clozaril versacloz)

iloperidone (fanapt)

olanzapine (zyprexa)

paliperidone (invega)

quetiapine (seroquel)

risperidone (risperdal)

Dementia medication types

Acetylcholinesterase inhibitors

NMDA receptor blocker

Acetylcholinesterase inhibitor side effects

GI distress and liver toxicity

NMDA receptor blocker

Tiredness

Body aches

Joint pain

Dizziness

GI distress

Acetylcholinesterase inhibitors

NMDA receptor blockers are

Ofte used together

Effective in mild/moderate dimentia

2 weeks to see improvement

Impact on GI system

Other medications used with dementia

antipsychotics

Common acetylcholinesterase inhibitors

donepezil (aricept)

galantamine (reminyl)

tacrine (cognex)

rivastigmine (exelon)

Common NMDA receptor blockers

Memantine (Namenda)

Better alternatives than meds with dementia

Provide meaningful therapeutic activities

Cognitively stimulating activities

Modify the environment to safely promote independence/confidence

Caregiver support